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5 common reasons for workers’ compensation denials in NC

On Behalf of | Mar 2, 2023 | Workers' Compensation

You are not alone if you recently received a workers’ compensation claim denial in North Carolina. Claim denials are more common than you might think. Regardless, you are probably wondering why this happened.

Here are five possible explanations for your workers’ compensation claim denial.

1. The injury did not happen at work

Workers’ compensation applies exclusively to injuries that happen during paid working hours. For example, if you trip and fall in the parking lot on your way to work and fracture your hip, you cannot receive workers’ compensation because you were not on the clock.

2. Too much time has passed

In North Carolina, you must report a workplace injury to your employer within 30 days. You then have up to two years to file an official claim for benefits. If your claim fell outside these boundaries, this could be the reason for your denial.

3. There was no accident

Except for hernias and back injuries, North Carolina workers’ compensation law requires you to point out a specific accident that caused your injury. Workers’ compensation does not cover injuries from performing standard work tasks in a typical manner.

4. Intoxication plays a role

If you were under the influence of alcohol or non-prescription controlled substances at the time of the injury, you might not be eligible for compensation. A potential exception to this rule is if your employer or a supervisor provided the substance that led to impairment and injury.

5. Your employer disputes your claim

Your employer may dispute your claim for a variety of reasons. However, they must notify you of the reason they chose to deny it.

A workers’ compensation claim denial is not a definite end to the story. You can appeal the decision and try to obtain the benefits you need to recover.